August 31, 2012

Kamara Supplies, Inc. v Clarendon Ins. Co. (2012 NY Slip Op 51718(U))

Headnote

The relevant facts the court considered in this case were that Kamara Supplies, Inc. was seeking to recover assigned first-party no-fault benefits, and the defendant, Clarendon Insurance Company, submitted an affirmed peer review report in support of its cross motion for summary judgment dismissing the complaint on the ground of lack of medical necessity. The main issue decided by the court was whether the defendant's peer review report clearly established a sufficient medical rationale and factual basis to demonstrate a lack of medical necessity for the supplies at issue. The court held that the defendant's cross motion for summary judgment was properly denied because the affirmed peer review report failed to establish a lack of medical necessity for the supplies at issue. Therefore, the court affirmed the order, without costs.

Reported in New York Official Reports at Kamara Supplies, Inc. v Clarendon Ins. Co. (2012 NY Slip Op 51718(U))

Kamara Supplies, Inc. v Clarendon Ins. Co. (2012 NY Slip Op 51718(U)) [*1]

Kamara Supplies, Inc. v Clarendon Ins. Co.

2012 NY Slip Op 51718(U) [36 Misc 3d 153(A)]

Decided on August 31, 2012

Appellate Term, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on August 31, 2012

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : PESCE, P.J., RIOS and ALIOTTA, JJ
2011-572 K C.

Kamara Supplies, Inc. as Assignee of ISMELDA JIMENEZ, Respondent, —
against
Clarendon Insurance Company, Appellant.

Appeal from an order of the Civil Court of the City of New York, Kings County (Carolyn E. Wade, J.), entered September 20, 2010. The order, insofar as appealed from as limited by the brief, denied defendant’s cross motion for summary judgment dismissing the complaint.

ORDERED that the order, insofar as appealed from, is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals, as limited by its brief, from so much of an order of the Civil Court as denied its cross motion for summary judgment dismissing the complaint on the ground of lack of medical necessity. [*2]

As the affirmed peer review report submitted by defendant in support of its cross motion failed to clearly establish a sufficient medical rationale and factual basis to demonstrate a lack of medical necessity for the supplies at issue (compare Delta Diagnostic Radiology, P.C. v Integon Natl. Ins. Co., 24 Misc 3d 136[A], 2009 NY Slip Op 51502[U] [App Term, 2d, 11th & 13th Jud Dists 2009]; Delta Diagnostic Radiology, P.C. v American Tr. Ins. Co., 18 Misc 3d 128[A], 2007 NY Slip Op 52455[U] [App Term, 2d & 11th Jud Dists 2007]), defendant’s cross motion was properly denied. Accordingly, the order, insofar as appealed from, is affirmed.

Pesce, P.J., Rios and Aliotta, JJ., concur.
Decision Date: August 31, 2012